Open Journal of

Pediatrics & Neonatal Care

Research Article

Affects of Adolescent Pregnancy on

Health of Baby -
N. Cinar* and D. Menekse
Department of Pediatric Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey

*Address for Correspondence: Nursan Cinar, Sakarya University, Faculty of Health Sciences,
Esentepe Campüs, 54187, Sakarya, Turkey, Tel: +0264-295-66-21; Fax: +0264-295-66-02; E-mail:
ndede@sakarya.edu.tr

Submitted: 29 November 2016; Approved: 20 February 2017; Published: 22 February 2017

Citation this article: Cinar N, Menekse D. Affects of Adolescent Pregnancy on Health of Baby. Open
J Pediatr Neonatal Care. 2017;2(1): 012-023.

Copyright: © 2017 Cinar N, et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
 Open Journal of Pediatrics & Neonatal Care

ABSTRACT
The effects of adolescent pregnancies on child health are discussed in this paper. In recent decades adolescent pregnancy has
become an important health issue in many countries, both developed and developing. According to WHO data in 2010, there are nearly
1, 2 billion adolescents in the world, which consists of 20% of the world population. 85% of these adolescents live in developing countries.
A pregnancy in adolescence, which is a period of transmission from childhood to adulthood with physical, psychological and social
changes, has been a public health issue having an increasing importance. Individual, cultural, social, traditional or religious factors play
a great role in adolescent pregnancies which are among risky pregnancies. In the related studies, it is obviously stated that adolescent
pregnancies, compared to adult pregnancies, have a higher prevalence of health risks such as premature delivery, low birth weight
newborn, neonatal complications, congenital anomaly, problems in mother-baby bonding and breastfeeding, baby negligence and abuse.
As a result, it is clear that adolescent pregnancies have negative effects on the health of children. Both the society and the health
professionals have major responsibilities on this subject. Careful prenatal and postnatal monitoring of pregnant adolescents and providing
of necessary education and support would have positive effects on both mother and child health. In this review, we have discussed affects
of adolescent pregnancy on the health of a baby.
Keywords: Adolescent; Adolescent mothers and their child; Health outcomes; Pregnancy

INTRODUCTION low level of education among mothers [1,5,13-15] a lower economic

In recent decades adolescent pregnancy has become an important
health issue in many countries, both developed and developing
[1]. According to WHO data in 2010, there are nearly 1,2 billion
adolescents in the world, which consists of 20% of the world
population. In developing countries, 85% of these adolescents live
[2]. Among the adolescent girls between the ages of 15-19, nearly
16 million births are seen in 2008, and this number consists of 11%
of the world population [3]. Although adolescent pregnancy is a
serious health (anemia, hypertension, preeclampsia and eclampsia,
abortion, assisted delivery, stillbirth, maternal complications and
postpartum depression) and social problem (decreasing self-
confidence, disruption of adolescent mother, departure from social
activities) worldwide, more than 90% of cases occur in developing
and developed countries and carry considerable risk [4,5]. In the
United States, 9% of women aged 15 to 19 years become pregnant
each year of which 5% will deliver a baby, 3% will choose to have an
induced abortion, and 1% end in miscarriage or stillbirth [6,7]. The
USA has the highest incidence (52.1 per 1000 15 to 19 year-olds) in
the developed world and the UK has the highest incidence (30.8 per
1000 15 to 19 year-olds) in Europe [4,8].
The vast majority of these births (95%) occur in low- and middle-
income countries [9]. The 2014 World Health Statistics indicate that
the average global birth rate among 15 to 19 years old is 49 per 1000
girls. Adolescent Delivery Rate (ADR) ranges from 1 to 299 births
per 1000adolescent girls, with the highest rates in countries of sub-
Saharan Africa [9].
According to Turkey Demographic and Health Survey (TDHS)
2013 data, 17.2% of the population that is nearly 1/5 of the population
is comprised of 10-19 years old adolescents [10]. It is stated that the
percentage of motherhood in adolescence increases corresponding to
the age, thus, 0.0% in 15 years old, 0.5% in 16 year olds, 3.4% in 17
years old, 4.6% in 18 years old, 16.2% in 19 years old. According to the
TDHS 2008 data, the percentage of adolescent mothers was 6%, while
that of TDHS 2013 was reduced to 5% [10]. In Turkey, a study by the
Ministry of Health was conducted in 81 provinces in order to detect
adolescent labors. It was seen that adolescent labor number and rates
were higher in provinces in the East and generally in the provinces
that were identified as district health centers and in the provinces that
received immigrants [11].
Individual, familial and social factors have a great role in the
increase of adolescent pregnancies [12]. In the studies conducted, the
status [5], non-working mothers [1,4,5,16], mother’s smoking [4],
lack of information about contraception and early sexual activity [17]
are all factors that affect adolescent pregnancies. The study indicates
that there is a significant correlation between ethnicity and adolescent
pregnancy [4]; however, there are also studies claiming no between
them [5].
In a study conducted in Turkey, adolescent pregnancy is seen that
73.8% is in illegal marriages at the age of 12-17 and 24.4% in illegal
marriages at the age of 18-19 [18]. According to the current Turkish
civil laws in force, illegal marriages are not valid, but a considerable
number of these couples preferred religious marriages, which are
not defined as a legal marital status [18]. In Thailand, 91.6% of the
adolescent mothers below 20 are single parents [19]. Illegal marriages
or divorce in adolescent mothers are other factors that negatively
affect maternal and infant health
Giving birth to a child during the adolescent years frequently is
associated with long-term adverse consequences for the child [20].
Together with biological immaturity, factors such as unintended
pregnancy, inadequate perinatal care, poor maternal nutrition, and
maternal stress may cause adverse obstetric and neonatal outcomes
in pregnant adolescents [18].
It is possible to examine the effects of adolescent pregnancies on
baby health under certain categories (Figure 1), which we will explain
the following sections.
Preterm birth / premature infant / preterm delivery
Preterm is defined as babies born alive before 37 weeks of
pregnancy [21]. The rates of preterm birth, low birth weight, and
asphyxia are higher among the newborns of adolescent mothers, all
of which increase the risks of death and of future health problems for
the baby [22]. Preterm birth is another important perinatal challenge
faced in clinical practice. Several studies have explored long-term
health outcomes for premature infants, including chronic lung
disease, visual and hearing problems and neurodevelopment delays
[23,24].
In the studies conducted, the rates of preterm birth in adolescents
and adults are detected as the following; Mukhopadhyay, et al. [15]
27.7% - 13.%, Omar, et al. [5] 22.5% - 2.9%, Rasheed, et al. [24] 13.2%
- 5.6%, Edirne, et al. [14] 28.4% - 14.7%, Duvan, et al. [25] 18.5% -
8.7%, Kovavisarach, et al. [19] 12.1% - 7.1%, Gupta, et al. [4] 8.7%

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 Open Journal of Pediatrics & Neonatal Care

(1.8%), infection (0.9%) and postpartum traumatic stress (0.5%) were

Figure 1: The effects of adolescent pregnancies on baby health.
- 7.6%, Keskinoglu, et al. [18] 18.2% - 2.1%, Akdemir, et al. [26] 16%
- 1.8%. There is a significant difference between them (Table 1).
Low birth weight
Low Birth Weight is characterized by the fetus below 2500 grams,
and very low birth weight is the birth weight of the fetus below
1500 grams Low birth weight is closely associated with fetal and
neonatal mortality and morbidity, inhibited growth and cognitive
development, and chronic diseases later in life [27]. In many studies,
it is seen that there is a positive relationship between the adolescent
pregnancy and low birth weight of the infant [4,14,15,28].
Low Apgar score
In some studies, it is expressed that the average Apgar scores in
the 1st and 5th minutes are below 7 [25,29] the Apgar scores in the
1st and 5th minutes are below 7 [16,30], which reflects no difference
listed among neonatal complications. In the study by Omar, et al. [5],
it is stated that the rate of perinatal complications in the first 24 hours
is 18.2% in adolescents, and 4.9% in mothers between 20-35 years
old. In the studies, it is found out that the rate of premature rupture
of membranes in adolescent pregnancies is 2.2% [18], 20.9% [24] and
16.39% [31].
Infant deaths
As one of the indicators of a country’s health status, infant deaths
have a great importance. According to 2013 data of TDHS in Turkey,
infant death rate is significantly high among mothers younger than
20 (25 per thousand), 20-29 years old (14 per thousand) and 30-39
years old (25 per thousand) [10]. Infant mortality seen in adolescent
pregnancies is given in (Table 2).
A study in the city of Sakarya in Turkey determines that postnatal
infant death rate is 2.5% in adolescent pregnancies and 0.1% adult
pregnancies [26]. Malabarey, et al. [7] in their studies in the USA
evaluate the effect of young maternal age on adverse obstetrical
and neonatal outcomes. They stated that the rate of infant deaths in
pregnant adolescents below 15 is 0.86%, and it is 0.41% in pregnant
adolescents over 15. In another study conducted in the USA, the rate
of neonatal mortality is reported as 7.3% between the ages of 10-15,
4.9% between the ages of 16-17 and 4.1% between the ages of 18-
19, so, the younger the mothers are, the higher the rate of deaths is
[27]. In a study conducted in India, it is stated that the rate of infant
deaths earlier than 48 hours is 5.1% in adolescents and it is 1.7% in
adults, which is significantly a high rate [15]. The increased neonatal
mortality in infants born to teenage mothers might be mediated by
Table 1: Rates of preterm birth in adolescent and adult mothers.
Rates of Preterm Birth
Studies
Adolescents Adults
Mukhopadhyay, et al. [15] 27.7 13.1
Omar, et al. [5] 22.5 2.9
Rasheed, et al. [24] 13.2 5.6

between adolescents and adults. The rate of infant Apgar scores below Edirne, et al. [14] 28.4 14.7
7 is 10.1% in adolescents while it is 1% in adults [5]. Duvan, et al. [25] 18.5 8.7

Congenital abnormalities Kovavisarach, et al. [19] 12.1 7.1

The rates of congenital abnormalities in adolescent deliveries are Gupta, et al. [4] 8.7 7.6

detected as 1.1% [19], 2.51% [31], 0.9% [15]. In adolescent deliveries, Keskinoğlu, et al. [18] 18.2 2.1
cardiovascular and central nervous system abnormalities are most Akdemir, et al. [26] 16 1.8
widely seen among the major congenital abnormalities [31].
In adolescent pregnancies, the risk of developing central Table 2: The rate of infant deaths in adolescent pregnancies.
nervous system abnormalities such as anencephalia, sipina bifida / Rate of infant deaths
Studies Age
meningocele, hydrocephalus/microcephalus; gastrointestinal system (%)
abnormalities such as omphalocele, gastroschisis; musculoskeletal Akdemir, et al. [26] Ages of 10-19 2.5
system abnormalities such as cleft lip and cleft palate, polydactyly, (city of Sakarya in
Turkey) Ages of 20-35 0.1
syndactyly increases [17]. Adult and adolescent mothers are compared
Ages of below 15 0.86
in terms of iron folic tablet administration and it is seen that adult Malabarey, et al. [7]
(USA)
mothers (49.1%) use more iron folic tablets than adolescent mothers Ages of over 15 0.41
(40%), and that there is a significant difference between them [15]. Ages of 10-15 7.3
Chena, et al. [27]
Neonatal complications Ages of 16-17 4.9
(USA)
Ages of 18-19 4.1
In the study by Keskinoğlu, et al. [18], conducted in Izmir with
Mukhopadhyay, et al.
the adolescent mothers, meconium aspiration (8.7%), respiratory Ages of 13-19 5.1
[15]
distress (2.3%), cordon presentation (2%), Rh isoimmunization (India) Ages of 20-29 1.7

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 Open Journal of Pediatrics & Neonatal Care
low weight gain during pregnancy, preterm birth, and/or low birth
weight in teenage pregnancy [27]. Because Adolescent pregnancies
during pregnancy are may have maternal weight gain, inadequate
prenatal care, due to pregnancy have a high risk for hypertension and
preeclampsia [26].
Problems in the mother-baby bonding process
Bonding, which develops in three periods; pregnancy, labor and
after the birth, is a mutual emotional relationship [32,33]. It deeply
affects the physical, psychological and intellectual development
of the child and retains its effect whole life. Parents have to play a
key role in order to maintain a healthy process [33]. Motherhood in
adolescence is accepted as a risk factor for an adequate relationship
between mother and infant and for the subsequent development of
the infant [34].
The mother-child bonding is deteriorated in the first years of
the child’s life, especially because the mother is still immature and
is undergoing a period of development [35]. It is found out that
adolescent mothers, compared to adults, have a lower tendency
to touch, call, smile at and accept their babies [36]. In a study by
Crugnola, et al. [34] it is expressed that adolescent mothers spend
more time establishing a poor relationship and that they play less
with their babies. In our literature reviews, we found out that there
was limited number of studies on this subject. Informative studies are
required on this subject.
Duration and success of breastfeeding
Breastfeeding practices among adolescent mothers is a
biopsychological process which includes negative and positive factors
along with the importance of social support in the intention of
breastfeeding, starting and continuing of breastfeeding [37]. Despite
substantial evidence of maternal and infant benefits of breastfeeding,
adolescent mothers initiate breastfeeding less often and maintain
breastfeeding for shorter durations when compared to their adult
counterparts [38].
The intention of breastfeeding is an important determiner in
the starting and continuing of breastfeeding. McDowell, Wang, &
Kennedy-Stephenson [39] have reported in their study that 43%
of adolescent mothers, 75% of mothers between 20-29 and 75%
of mothers above 30 have the intention of breastfeeding. Kyrus,
Valentine, & DeFranco [40] have emphasized that adolescent
mothers (44%) have a lower rate of breastfeeding intention than adult
mothers (65%), which is influenced by an insufficient social support
and poor socioeconomic conditions. It is more probable for mothers
having breastfeeding intention to start breastfeeding [41]. Kyrus, et
al. [40] have stated that breastfeeding rates in deliveries before 37
weeks are 20.9% for adolescent mothers younger than 15, 40.7% for
mothers between 15-19, 56.8% for mothers older than 20, and that
breastfeeding rate significantly decreases as the mother is younger.
Teenage mothers’ breastfeeding experiences may be similar to
adult women’s breastfeeding experiences, but teenage mothers may
require additional breastfeeding support [42]. Oddy, et al. [43] have
reported that 12.6% of the mothers below 20, 27.2% of the mothers
between 20-24 and 29.9% of the mothers between 25-30, 21.5% of the
mothers between 30-34 and 8.9% of the mothers older than 35 have
breastfed their babies for less than 6 months. As for breastfeeding for
more than 6 months, mothers younger than 20 have the least rate of
breastfeeding (3.2%).
It which is conducted in a bistate metropolitan area in the
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Midwestern United States is emphasized that the interactive education
given to the adolescent mothers by the team of lactation and peer
consulting has a positive effect on their breastfeeding initiation
and duration up to 6 months postpartum [38]. It is essential that
breastfeeding education is given to adolescent mothers and familial
and social support is increased.
Infant abuse and negligence
Infants of adolescent mothers as a result of unplanned pregnancies
may face various problems They are at risk of abuse, neglect, and
school failure and are more likely to engage in criminal behavior
later on [5,44]. Adolescent mothers may not possess the same level
of maternal skills as adults do. There is a debate in the literature
regarding the association between maternal age and child abuse [45].
It is emphasized that children of adolescent mothers have a higher
rate of maltreatment [46]. In most studies, it is stated that children of
adolescent mothers are exposed to a higher rate of unjust treatment
in many ways, compared to the children of adult mothers [47,48].
It is reported that children of adolescent mothers are at risk in
terms of cognitive and social development. Negative environmental
conditions, including lack of stimulation or close and affectionate
interaction with primary caregivers, child abuse, violence within the
family, or even repeated threats of physical and verbal abuse during
these critical years can have a profound influence on these nerve
connections and neurotransmitter networks, potentially resulting in
impaired brain development [49]. Mother’s lack of knowledge and
experience on motherhood and baby care is a risk factor of child
neglect.
CONCLUSION
Adolescent pregnancy is a common public health issue for both
the mother and the child in terms of health, emotional and social
outcomes. Adolescent pregnancies which have an important role in
child health are an issue that should be carefully evaluated. In this
compilation, the effect of adolescent pregnancies on the health of a
child is discussed. Upon a literature research, it is seen that pregnant
adolescents have greater health problems during pregnancy, labor
and after labor, compared to pregnant adults. As for the baby,
it is reported that premature labor, low birth weight, neonatal
complications, congenital abnormalities, problems in mother-child
link and breastfeeding and child abuse and neglect are among the
problems that are widely seen as a result of adolescent pregnancies.
The factors affecting this condition are emphasized as the educational
and occupational status of the pregnant adolescent, socio-economical
conditions, marital status, and family structure, racial and ethnic roots.
The risk factors for adolescent pregnancy are multiple and complex.
In order to clarify this issue, more comprehensive epidemiological
studies which evaluate the effect of adolescent pregnancies on child
health are needed.
As a result, it is clear that adolescent pregnancies have negative
effects on the health of children. Both the society and the health
professionals have major responsibilities on this subject. Careful
prenatal and postnatal monitoring of pregnant adolescents and
providing of necessary education and support would have positive
effects on child health.
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